- Mrs. Cherry Pie
- 2 years ago
- Wedding: September 2008 - A tiny town just outside of Glacier National Park
On Saturday, April 26, I was 38 weeks pregnant. I decided to start gentle, “natural” induction measures as I had heard that many of them take some time to begin to be effective. That day, I took two oral doses of Evening Primrose Oil, morning and evening, had my first acupuncture treatment to stimulate labor, and drank my first cup of Late Pregnancy and Labor Tea. I went to a Massage for Labor class with a friend, then had dinner and went to a ukelele concert.
Throughout my pregnancy, I had strong feelings that my baby was going to arrive early and via a fast labor. My mother had four very fast labors (6 hours at the longest) and I, her first, was two weeks early. I don’t think many people believed me when I told them, because most first pregnancies are term or later and have long labors, but I made sure to share my feelings so that I at least could laugh about it later if it was just wishful thinking.
Sunday, April 27, 3:00 PM: My water broke. I was sitting on the toilet when I felt two small popping sensations, like cracking my back. But since that had never happened while pooping before, and I’d heard about the “pop” of membrane rupture, I thought, “this is it!” There was no big gush, and thankfully no meconium from what I could see. I ran downstairs and got the pH test strips for our hot tub and put a few drops of fluid on it. Sure enough, strongly alkaline!
DH had just texted me that he had been called in to work a shift for a coworker who was having a root canal the next day. “Not anymore!” I thought. I paged my midwife at 3:07 and set an appointment for 4:15 to confirm that my water had broken and start IV penicillin for being GBS+. My “12 hour clock” started counting down to when they would have to induce labor if I didn’t start laboring naturally. I took a shower, during which I started leaking clear (yay!) fluid, and my adrenaline level started to climb. After that, I did a few things around the house, sent a some emails, and went drove drove up the street to see my midwife.
4:15 PM: By the time I arrived at my midwife appointment, my pants were soaked (oops.) and it was obvious that there would be no need for an internal exam to confirm that my membranes had ruptured. My midwife started my IV for penicillin, and I called DH to let him know that he won’t be going in to work tomorrow… baby was coming!
As I waited for the IV drip to finish, I let other people know that today was the day we were to welcome our baby girl. I had previously felt some mild cramping in the shower, but as I was sitting there, I started having my first small contractions. They were irregular but each one was clearly stronger than the last. I told the midwife that I was already having to pay attention to them, but she said it was too early to start timing. She was glad that I wouldn’t need induction measures to speed things along. The plan at that point was for me to do things at home while in early labor and to see the midwives at 8:30pm for my second dose of penicillin. It was clear that they didn’t think I’d need to be seen before then.
5:15 PM: I headed home from the midwife. At this point, I was by myself as I had told DH to stay at work until his shift ended at 7:45. We had planned for a home birth by midwife with a labor tub being delivered on-site. Our birth was also to be attended by two of our close friends, a doula, and photographed by a birth photographer who is a colleague of mine. I started to make the calls to everyone and get the house ready. I reminded everyone I could that I thought labor might progress rapidly. I felt that a few people brushed off my feelings
5:30 PM: My friend Sarah arrived at the house to help me prep for the birth, having narrowly escaped a ticket on the way home from her Birth Assistant class. At that point, my contractions were really starting to bother me a bit, and Sarah began trying to time them. I found it hard to tell her when they stopped and started, so I tried to distract myself further with household tasks and setting up for the birth. I still assumed I might be in prodromal labor for several hours, so I got out the puzzles we’d picked up for people to do, set out my “comfort measures for labor” basket, and brought down the supplies for the midwives and my “bail bag.” Each task took me longer to do as I found it harder and harder to concentrate.
5:44 PM: Things were getting intense. I called DH to tell him there was a change of plans. I needed him to come home from work and help support me… already! I was starting to feel alone without him there, and it was clear to me (although other people still had a hard time believing it) that things were happening fast. Contractions were about three minutes apart. Around then, the labor tub arrived and Sarah and I helped get it in place while they filled it from the tap. Thank God for on-demand hot water heaters or I never would have been able to use the thing before it was filled (with tank heaters, they can often only get half full on one tank of water!).
I called my doula, Rebecca, to request her help. She seemed a little worried that I was asking for her only an hour and a half after my first contractions but agreed to come over right away.
6:04 PM: Rebecca arrived and assisted me to the bedroom, where I started laboring while leaning on a yoga ball that was propped on the bed. I asked Rebecca and Sarah to put counterpressure on my hips to help with the feeling of my sacrum burning. I don’t think I was having back labor, but I always liked having my sacrum pressed on, so it seemed like the thing to do. I kept expecting to have space between contraction to relax, but they were coming strong and faster, each one gripping me completely. By the time I can relax from one, the next was upon me. I imagine I can feel myself dilating, and quickly, but it seems almost impossible.
I tried to think about something, anything, to give me a mantra — a connection to other women? NOPE. Still like a mountain, flow like the river? NOPE. Excitement to meet baby? NOPE. Maybe listening to music? NOPE. There were no thoughts, only my breath and a momentary pause between each gripping contraction. I wouldn’t say I was in terrible pain, but I was intensely consumed by the sensation and unable to do anything but lay there and breathe in and out.
6:17 PM: Still alone with Rebecca and Sarah. I was fed up that DH wasn’t home yet and texted him “please come now.” He walked in the door three minutes later to find me clearly in active labor, with contractions less than two minutes apart. He paged our midwife at 6:26 to let her know that they should check in with us. All pages were supposed to be answered in 10 minutes, but ten minutes later there was no response. At 6:42, DH paged both numbers again and called the cell phones of both midwives. There was still no response.
Rebecca encouraged me to try to urinate. I did so, and there was mucous and a bit of blood. It was the first sign that I was losing my mucous plug. I labored through two huge, back-to-back contractions on the toilet before feeling hugely uncomfortable and in real pain. I gave up on laboring on the toilet and went back to the bedroom to lean over at the bedside again.
7:07 PM: The labor tub was completely full. Thank GOD! I whipped off all my clothes and was in there before anyone could object or tell me it was too early. Once I was in the tub, I was immediately more comfortable. It didn’t make the pain go away, but I felt less “heavy” when gripped by a contraction. The insane intensity of it was more manageable with warmth and weightlessness. I labored kneeling at the edge of the tub with my arms on the padded side where I could drink water and have a cool cloth laid on my head.
While I was laboring, I imagine I drank a gallon of water… between each contraction I easily downed a quarter of a pint glass of juice/ice water. I was SO thirsty.
DH tried one of the midwives’ phones again, and there was STILL no response. We were getting frustrated and worried.
7:12 PM: One of the midwives FINALLY returned our call (45 minutes after first page! Argh!), profusely apologetic. After learning how my labor was progressing, she assured us she would be on her way immediately.
Sarah’s husband, Zach, arrived with straws to help me drink water more easily and a batch of tacos for everyone else on our birth team.
7:20 PM: I started to feel downward pressure, possibly like I MIGHT want to push. It was all happening so fast! The midwives still weren’t at our house, and neither was our birth photographer. My brain was screaming “too soon, too soon!” I was determined not to push until the midwives arrived, both so they could tell me if it was OK (I really didn’t want to push at 6cm and waste energy) and so the baby wouldn’t arrive without someone to help deliver her! As a photographer, birth photography was very important to me… and I was really concerned that I might have the baby before we had any photographs of the birth.
7:35 PM: Our midwife arrived with a birth assistant in tow. Actually, the birth assistant was another midwife who happened to be out to dinner with our midwife when they realized they needed to be on call. The OTHER midwife was technically supposed to be on-call but was unresponsive. SHE arrived a few minutes later, so I was then being attended by BOTH midwives and a midwife acting as a birth assistant. Better too many than too few!
I realized that I was laboring almost entirely with my eyes closed. I’m surprised to discover how many people are in the room when I open them.
Ice was added to the tub to cool it down after it’s determined that my temperature is running hot. Baby’s heartrate was checked and determined to be fine.
Despite my best efforts not to push, I had started spontaneously bearing down and grunting.
7:50 PM: The midwives were all set up and situated. I asked for a cervical check to see how things are progressing. This was the first and only internal exam I had my entire pregnancy.
One of the midwives said she would check me, but it might be difficult to tell in the tub how dilated I am. I remember thinking, “well, you’d better do it because like hell I’m getting out of this tub.” The midwife checked me and her eyes got big. “Well,” she said, “You can reach down and just inside, you’ll feel baby’s head. You’re almost completely dilated, and +3 station, and if you feel the urge, you can push at any time.” I remember thinking that I was really, really glad that my feelings about the speed of my labor, and dilation, and the pressure were all spot on… if she had told me I was at 4cm or something, I might have given up at that point.
Per her advice, I reached down and felt a soft bulge inside myself, and I remember finding the softness quite concerning. My midwife told me that was the fontanelle and to feel a little farther back and there would be the firmness of her skull… and there it was. So weird!
Since it was time to get to pushing, DH stripped down to his skivvies and got into the tub. I laid back against him and tried to get comfortable. In retrospect, I think I would have enjoyed pushing in a more upright position, but I didn’t have a lot of brains to think at that point, so I just let my body do the work. I remember someone trying to feed me a popsicle around then, probably when I was in transition, and it just made me nauseated. I really didn’t want to throw up in the tub.
8:04 PM: Pushing. Finally, the photographer arrived!!
Pushing was a lot less painful and intense than looking down the barrel of my previous contractions, but it was really intensely uncomfortable. There was definitely a lot more “doing” involved and I had a difficult time navigating the sensation of when to push and when to stop. Between pushes, the baby would move back up, in the whole “two steps forward, one step back” pattern, but I found this really distressing. I wanted to hold her in the downmost position when everyone else was trying to advise me to let her go back up and relax during pushes. It felt somewhat counterintuitive. Mostly, it was just really uncomfortable and frustrating. I think I was irrationally worried that she’d split me wide open and come flinging out with no one to catch her, so I started to hold my hands out in front of myself (WAY too early) as if I might have to grab her as she went shooting by.
8:26 PM: Still pushing. The baby’s head became visible and someone said “she’s blonde!” (I remember this later as being untrue… she had dark hair, to our surprise!) The midwives continued to check her heart rate regularly and except for one instance where they couldn’t find it for a moment, it followed a healthy pattern of slowing during a push and then going back up to normal rates.
More of the baby’s head became visible every 1-2 minutes. I was able to put pressure on my own perineum and as I started to feel burning sensations, hissed to slow pushing and work through the feeling. I remember being worried about how much this part would hurt, but the stretching burned less than I thought it would. I still felt too small, and that was intensely frustrating.
8:38 PM: Her head was out! In another 35 seconds, so was her body. I was a little too busy pushing to catch her, so the midwives delivered her. She came out of the water screaming and covered in vernix. Her APGAR score was 9 at birth, -1 for color, and 10 at 5 minutes post delivery. 7lbs 9 oz and 20.5 inches long! She laid on my chest, quiet and alert, and waited with us for her placenta to be delivered.
I had a non-complex second-degree tear (perineal surface and some internal muscle), which I did not feel happening.
8:45 PM: DH cut her cord.
I thought it was a little odd that I wasn’t having any more contractions, but I knew that it could take a while for a placenta to be delivered.
8:55 PM: I started to lose a bit of blood, so the midwives moved me from the labor tub to a birthing stool to deliver the placenta. I still wasn’t have any more contractions. I gave one or two good pushes per their instructions after about five minutes, but that just resulted in a burst of blood and unhappy midwives.
9:00 PM: They laid me on my back on the kitchen floor on top of towels and started uterine massage. I was given a shot of pitocin in my thigh, which seemed to do absolutely nothing. Still no placenta.
9:10 PM: We all moved back to the bedroom, where I was laid sideways across the bed and made another attempt to push out the placenta (still with no contractions). Nothing. I was given another shot of pitocin in my thigh and a dose of Angelica, a homeopathic thought to help. The midwives applied gentle traction to the placenta. Each attempt at delivery only resulted in a bit more blood loss, which while concerning, was still not at critical levels. My blood pressure and pulse rate were stable, but it was starting to be clear that the placenta was not going to be delivered spontaneously.
9:24 PM: The baby (still nameless) was placed at my breast and she latched to feed. We hoped this would inspire uterine contractions for placenta delivery (self-stimulation of nipples had not), but no dice. That placenta didn’t seem to want to go anywhere.
With how long it had been since the birth and my blood loss, we were told that I would have to have my placenta manually extracted. Meaning, someone would have to reach up inside my uterus, fish around, grab it, and take it out while taking care to ensure it remained intact and didn’t cause me to bleed to death. We were given a choice: Do this procedure at home with no pain medication and (if successful) be done with labor and delivery — or (if not successful/blood loss, etc) be rushed to the hospital by ambulance , OR head to the hospital to have the same procedure done, with pain meds, probably an an operating room, and definitely requiring an overnight stay.
I told them I wanted to attempt the manual extraction at home and for everyone to be ready in case anything went wrong. We placed my “bail bag” and a robe near the door.
9:37 PM: The midwife (the one with the smallest hands of the three, thank god) prepped for the procedure, including starting IV fluids and methergine, and told me that it would be intensely painful and to be ready for her to be “in there” about 40 seconds. DH handed our baby off to our friends to hold her so I could grab his hand while in the throes.
And then, she did it. Compared with the intensity of labor, it hurt far less than I thought it would. The midwife told me later that most women scream. I just cursed like a sailor. Looking at photographs of my face while I was pushing versus during the extraction, it’s clear that I would have preferred more pushing over another extraction. It just felt really, really WRONG. But when it was done, the placenta was intact and my bleeding stopped. All told, I lost about 750ccs of blood, probably 250ccs more than normal. I was the color of paste.
10:00 PM: The midwives stitched me while I fretted about it and felt generally amped up as a result of the methergine. Baby girl had her newborn exam and we three prepared for our first night together — during which I peed like a race horse (thanks to drinking so much and a litre of IV fluids) and slept not one wink for fear of bleeding to death. Baby girl slept the whole night for the first (and, to date, LAST time).
RECOVERY, POSTPARTUM ISSUES, and MILK SUPPLY:
We named our girl Coralin Jean on the second day after a lot of deliberation. Her birth was faster (and sooner) than we all expected, and we needed some time to process.
Regarding physical recovery, healing from my tear was easy. I was surprised that there was really no stinging when I used the bathrooom, though having a peri bottle really helped. I used padsicles with witch hazel a few times and took a few sitz baths when I had the time. Mostly, I felt for a few days like I had been crotch-punched, which I suppose in a way I had. I lost 16 of the 32 lbs I gained immediately following the birth, and another 6 in the week following. I’m a little soft around the middle and still have about 10 lbs on me (assuming some of this is still fluid, not fat), and it’s no big deal. My abdominal muscles remain intact, I’m not peeing myself, and my vagina seems pretty par for the course as far as vaginas go.
As for the emotional recovery, that was far more difficult for me, and for DH as well. Having a new baby left us both gripped with paralyzing fear and a lot of insecurity. Everything I read flew out of my head. Also, even though I wasn’t in any pain, it’s clear to me now that I was really shaky on my feet and pretty helpless because my body was still in a bit of shock. I wasn’t prepared for the sheer terror that I felt being given her to take care of. I was also overwhelmed by guilt that our baby was so fussy, distress that I wasn’t a good enough mother, and a lot of unexpected regret about the changes we were experiencing. DH lost 8 lbs from stress alone. Both of us were terrified we weren’t doing enough and didn’t know how to do the things we knew she needed.
Later, a friend posted this article on my Facebook timeline: http://www.huffingtonpost.com/claire-zulkey/15-things-about-new-motherhood-that-people-are-too-nice-to-tell-you-when-youre-pregnant_b_4992748.html?ncid=fcbklnkushpmg00000063 I wouldn’t have appreciated it while I was still pregnant, but it’s very, very true in retrospect. I DO feel that my birth experience was ideal and I didn’t feel disappointed by it, and DH and I haven’t fought a lot, but the rest has been true for me.
Cora lost 5.8% of her birth weight (7lbs 9 oz) by day 4 and recovered her birth weight by day 7. She seemed to be nursing well, but had started to be really fussy and inconsolable. Whenever she wasn’t asleep, she was screaming, and she had to be held while sleeping, or she would scream more. She furrowed her brow, arched, and flexed. We weren’t sure if this was normal “week 2 fussiness” and gastric distress or something more serious. Our pediatrician prescribed Zantac for reflux at her 2-week visit, but we were still left with an angry, inconsolable baby, and a feeling that something was wrong. At this visit, she also hadn’t gained much weight up from her birth weight (7lbs9oz) and was only at 7lbs10.5oz.
Most medical professionals had by this point commented on Cora’s tight frenulum (tongue tie), but as she seemed to latch fine, they said we didn’t need to get it cut unless it became a problem. Well, she was latching fine, but would repeatedly break her latch, gulp down air, and scream at the breast. Breastfeeding was like an act of war, not a soothing, bonding time as it was “supposed” to be. Each time she wanted to be fed, she screamed, and each time she fed, she screamed, so I wore ear plugs around the house to constantly buffer the sound. We were miserable. We decided to have her tongue clipped to see if it would help.
After her frenulum was cut, Cora’s latch improved but we still struggled to get her to nurse effectively. She was lazy and although she was ALWAYS on the breast, she never seemed satisfied. She was also still “colicky” and we weren’t sure why. She did have some gas, so we sort of resigned ourselves to the fact that our postpartum baby experience was just going to involve a lot of earplugs and tears all around. Then we did another weight check… she had only gained one ounce more by week three than she had at week two. Instead of gaining half an ounce to an ounce and a half a day, she had put on TWO in TWO WEEKS. Something was wrong.
The pediatrician, horribly, spouted off a dozen things that could prevent her from gaining weight but not once mentioned low milk supply. We were told maybe she had a heart condition, an occult UTI, or some metabolic problem that a blood test could confirm. CLEARLY (in my mind) the first question in an issue of WEIGHT GAIN should have been “IS SHE GETTING ENOUGH FOOD.” When we asked about that, the pediatrician sort of went “oh, yeah, well, of course, you want to look into that first.” Yeah, DUH. That sort of worst-case-scenario medical advice is an awful method of care if you ask me, and we haven’t been back there since.
Immediately following that appointment, we had an appointment with a lactation consultant, who seemed to think that either Cora wasn’t transferring milk effectively or I simply had a low supply. Confirmed by the fact that the most I had been able to pump between feeds was 1.75oz, I was given a scrip for domperidone, an anti-emetic like Reglan not FDA approved but with similar effects on prolactin and fewer side effects on mood. I also started taking fenugreek, eating oatmeal, drinking a few dark beers, pumping out after each feeding, and anything else we could think of to hit the problem from all angles.
We decided that day to begin supplementing with formula while I enhanced my supply. While it was a difficult choice emotionally to go out and buy that first contained of formula, by the time we gave Cora her first bottle, I already felt a sense of relief that she would get enough calories.
Later that day, my midwife advised me to get an ultrasound to see if I might have retained placental matter from the birth that could be affecting my supply. I was able to get a same-day appointment, and a transvaginal image confirmed that there was abnormal areas of vasculature, which indicated retained placenta. I booked a D&C for two hours later and had it all scraped/sucked out. I wasn’t messing around any more.
At the D&C appointment, I was given a bHCG urine test to determine if my placenta bits were secreting hormones that might interfere with milk production. The bHCG test was negative, but a blood test revealed that my prolactin levels were only 54… within the “normal” range but less than half of “average” (most lactating women have a level of 80-120, or up to 200!). After the procedure, the resident said that it was good I had it done, as I most likely would have had to have a more major surgery at a later date as my body would probably not have gotten rid of the tissue on its own. That means that I would have had abnormal bleeding or infection, in addition to trouble breastfeeding.
While we can’t confirm that the D&C to remove the placental tissue has directly affected my supply, or if it’s been the fenugreek or domperidone (or pumping, or oatmeal, or beer, or simply Cora’s better latch), things are getting better. I don’t feel I’m where I need to be at as far as production quite yet, but Cora is gaining steadily and back on her growth curve. Our supplementation, which we augmented to include donor milk from some awesome generous friends, has declined from 8oz a day to 5oz, then 4, then 2, then finally yesterday I gave her no additional milk at all. The midwives told me that they now have a new protocol that anyone who requires a manual placenta extraction have a follow-up ultrasound at 7 days postpartum… it was four weeks before I had mine.
Since we started supplementation, Cora’s temperament has improved immensely. She’s gone from being an inconsolable screamer who spent every waking moment crying to a regular fussy baby with quiet alert times. So if you hear your baby crying and you think something isn’t right, I say trust your gut. Sometimes, babies just cry, and sometimes they need something more from you. Now, our biggest challenge is getting her to sleep without having to hold her. She just wants to be near us, despite our best efforts to get her to take naps and sleep without being attached to mom or dad. It’s getting better, but that part, we can handle.
Cora is five and a half weeks old and on the verge of giving us social smiles, though it might be a little longer because she was 2 weeks early. We’re looking forward to interacting with her more — newborn babies can take so much energy and it’s hard not to have a lot of social time in return. It’s a tough road, and many, many times, I shake my head and wonder how so many people do it and why on earth anyone would choose to have more than one child. I’m exhausted and constantly fretting, but I think now that we have some ground under our feet, we’ll be fine in the end.
Next week is our final midwife appointment — the 6 week postpartum visit! We’ll find out just how well I’ve recovered from my tear and see if I can move on to other things… like regular exercise and intimacy, when and if we have the time. Ha!